Bulletin for proposed CCGs – Issue 20, 13 September 2012

13 September, 2012

Contents

Welcome from Barbara Hakin

Dame Barbara HakinWelcome to the 20th edition of our fortnightly CCG bulletin.

This issue crucially sets out proposals going to our next Board meeting on 20 September which will discuss how the moderation, conditions and decision-making elements of the CCG authorisation process will operate.

Proposals have been put forward which aim to continue to achieve a balance between supporting the development of CCGs, as they move through authorisation and develop as new clinical commissioning organisations, and assuring that CCGs are able to commission safely and use their budgets responsibly.

There is a full update below, but I want to highlight a proposal to share the recommendations of the Conditions Panel with theCCGprior to decisions being made by the NHS Commissioning Board (NHS CB). The proposal, which has been developed in response to CCG feedback, means CCGs will have two weeks to comment and provide any new evidence that may remove the need for a specific condition.

If approved, it means the final authorisation decision by the CCG Authorisation Sub-Committee of the NHS CB will be four to five weeks later for each wave, and that first decisions onCCGauthorisation are due in November 2012, rather than October.

The additional two weeks, which was designed in consultation with CCGs, does mean that the final authorisation date for CCGs will be later. CCGs will however continue to receive the outputs and crucial information from the authorisation process at the original time, which means these changes will not have a material impact on the preparations or readiness of individual CCGs.

The sub-committee, which will make the final authorisation decisions, will be chaired by an NHS CB non-executive director (NED) and include two other NEDs, the NHS CB’s National Medical Director Bruce Keogh or Chief Nursing Officer Jane Cummings, the NHS CB’s Deputy Chief Executive and Chief Operating Officer Ian Dalton, and me. This gives us a strong clinical input to the final decisions.

Generally, we are on schedule with regard to the authorisation process and, as of this month, I’m very pleased to be able to say that every proposedCCGis now involved in an aspect of authorisation – from the stakeholder survey and desktop reviews, through to the site visits which commenced for Wave 1 CCGs on 4 September. I wish you all very well through the next stages of this exciting yet testing time.

The NHS CB is committed to working in equal partnership with and drawing on the expertise of CCGs to develop national policy, and the launch of the NHS Commissioning Assembly on 14 November will be a huge milestone in the development of this commitment. The Assembly, both as an annual national event and through its working groups, will be an invaluable asset to us all, allowing us to shape national policy and direction together as a single commissioning community. We hope to see the senior clinical leader from everyCCGon the 14 November – see below for more details.

Once again, I would like to thank you all for your continued dedication, enthusiasm and sheer hard work. If you would like to let me know about what you’ve been up to in your local area, or have any comments, questions or feedback then please can contact me via pathfinderlearningnetwork@nhs.net

Dame Barbara Hakin
National Director for Commissioning Development

Final authorisation decision-making process set out

The CCG authorisation governance process is set to be finalised at the NHS Commissioning Board Authority’s meeting inNewcastleon 20 September. A paper seeks the approval of the Board to further proposals on how the moderation, conditions and decision elements of theCCGauthorisation process will operate.

A key proposal is to share the recommendations of the Conditions Panel with theCCGprior to decisions being made by the CCG Authorisation Sub-Committee of the NHS CB. The proposal, which has been developed in response to CCG feedback, means CCGs will have two weeks to comment and provide any new evidence that may remove the need for a specific condition.

If approved, it means the final authorisation decision by the CCG Authorisation Sub-Committee of the NHS CB will be four to five weeks later for each wave, and that first decisions onCCGauthorisation are due in November 2012, rather than October.

The paper also proposes the membership and terms of reference for:

  • The Moderation Panel, chaired by National Director: Commissioning Development Dame Barbara Hakin, will meet once a month from October 2012 to January 2013, and will ensure overall consistency and make recommendations as to whether aCCGshould be fully authorised or authorised with conditions.
  • The Conditions Panel, chaired by Deputy Chief Executive and Chief Operating Officer Ian Dalton, will meet fortnightly from November, and will consider what support is required where a CCG has not supplied sufficient evidence to meet a threshold for one or more authorisation criteria. The output of the panel will be a report with the recommended conditions and support for each CCG. Regional directors would be given an opportunity to approve the recommendations made on conditions and support for each CCG being considered from their region prior to consideration by the Conditions Panel. They may choose to take informal soundings locally prior to the Conditions Panel on options where the panel is likely to consider that a CCG needs intensive support.
  • The CCG Authorisation Sub-committee will be chaired by an NHS CB non-executive director and will meet twice per wave between October 2012 and February 2013 to make authorisation decisions, and quarterly from March 2013 to consider the removal of conditions. The conclusions of each sub-committee meeting would be published immediately after each meeting, once decision letters have been issued to CCGs.

The Board paper outlines in full how the moderation and conditions/support processes will work, and how decisions will be made by the NHS CB.

It proposes that a standard review date of March 2013 will be built into all conditions and that CCGs may submit evidence to the relevant regional office which will determine whether the condition can be removed for the majority of conditions. For the more substantial conditions, the sub-committee will need to sanction their removal.

Following the decisions of the Board on 20 September, a factsheet on the process will be prepared and circulated to CCGs.

First meeting of NHS Commissioning Assembly set for 14 November

Dame Barbara Hakin will shortly invite the clinical lead (clinical chair or chief clinical officer) from every CCG to hold the date of 14 November for the launch and first annual national event of the NHS Commissioning Assembly.

Sir David Nicholson and the 15 emerging CCG clinical leaders who are leading the development of the assembly, working with the executive team of the NHS Commissioning Board Authority, recently wrote to CCG clinical leads setting out proposals for an NHS Commissioning Assembly.

The assembly would be the collective commissioning leadership forEngland, bringing together those leaders responsible for NHS commissioning decisions to create shared leadership for the healthcare system, and to deliver a shared work programme, in order to improve outcomes for patients.

The initiative includes the annual national event and several proposed working groups. Members will be the current clinical lead from each CCG inEngland, plus directors from across the NHS CB, including the local area team directors.

The design group is developing the detailed programme for the national event which will take place inDoncaster. It will focus on current, practical challenges and provide opportunities to share best practice and to network with colleagues.

Authorisation site visits commence

The site visits to the 35 CCGs in authorisation Wave 1 began on 4 September with NHS North Staffordshire CCG. They will continue throughout September.

The site visits are proposed CCGs’ opportunity to demonstrate the progress they have made since their desktop reviews and to provide further evidence to show that they meet the criteria set out in the Health and Social Care Act.

The panels, which will be chaired by people with significant NHS experience, who come from outside the local area, include: NHS CB regional directors, local area team directors and other directors, and other senior commissioning leaders. Every CCG has now been notified of their site visit date. Wave 1 CCGs have also been informed of the name of their panel chair.

In addition, all 67 proposed CCGs in the second wave have submitted their applications to the NHS Commissioning Board Authority, and their desktop reviews are underway.

Five proposed CCGs requested a change to a different authorisation wave, in line with their own operational plans. This means there will be: 67 CCGs in Wave 2 (instead of 70); 65 in Wave 3 (instead of 66); and 45 in Wave 4 (instead of 41). Waves 3 and 4 are due to submit their applications on 1 October and 1 November respectively.

The full list of authorisation waves is available here.

Give your views on the Commissioning Outcomes Framework and Quality Premium

Two Commissioning Outcomes Framework (COF) engagement events will take place in the next week. The events were set up as an opportunity for engagement and feedback to the NHS Commissioning Board Authority, NICE and the Health and Social Care Information Centre on the draft COF indicators for 2013-14 and on general issues for COF and quality development.

The events are:

  • Monday 17 September:  18:30 – 21:00(NHS London). Venue:  MWB, 10 Greycoat Place, SW1P 1SB. Contact  e-mail for the organiser: Gethin.Wood@London.nhs.uk
  • Tuesday 18 September:  09:30 – 16:00(NHS Midlandsand East).  ‘Improving Quality, Improving Outcomes’ event. Venue:  Hilton Hotel, Northampton  (M1  J15). Contact  e-mails for the organisers: dawn.denton@nhs.net  or jill.matthews1@nhs.net

Workshops have been advertised by Commissioning Development leads through their local networks in each region.  You may want to check with your CCG network colleagues, or the local organisers, to find out who will be attending from your area.

Strategic health authorities are also leading a series of regional engagement events on the Quality Premium at which CCGs will have the opportunity to ask detailed questions about the Quality Premium, and to test the proposals for the secondary legislation supporting it.

The scheme will enable CCGs to be rewarded for improving outcomes for patients across primary, community and secondary care.

Look out for invitations to your nearest regional events, which SHAs are currently finalising with the Board Authority.

Safeguarding children and adults in the future NHS

The NHS Commissioning Board Authority has published interim advice on arrangements to secure children’s and adults’ safeguarding which provides additional information, in particular, to proposed CCGs, linked to authorisation and beyond.

A covering letter reminds PCTs and SHAs of the vital importance of maintaining appropriate arrangements as the health system goes through transition.

The interim advice, with a covering letter from the Board Authority’s Chief Nursing Officer Jane Cummings and Acting Director General, Social Care, Local Government and Care Partnerships at the Department of Health Shaun Gallagher, is in the Resources for CCGs area of the Board Authority’s website under the ‘Safeguarding’ heading.

Procurement briefings for CCGs

Working with CCGs and other stakeholders, the NHS Commissioning Board Authority has developed a series of procurement briefings that summarise the key elements of legislation and guidance currently governing NHS procurement of healthcare services.

These briefings also provide an overview of the different procurement approaches that CCGs may adopt and outline some of the key considerations when undertaking a procurement process.

The briefing papers cover:

  • Introduction: Why do CCGs need to understand procurement?
  • How does procurement fit with the different stages of commissioning?
  • What are the procurement options?
  • Which rules apply to a procurement process?
  • How should a procurement process be conducted?
  • Summary of the decision-making process.

The briefings will be available on the Board Authority website this week.

Sign up for next commissioning webinar

The next webinar for CCG clinical leads is on 18 September, at 12.15 – 13.00, with log in from 12.00.

Led by National Director: Commissioning Development Barbara Hakin and Chief Financial Officer Paul Baumann, the webinar will focus on issues that CCGs have raised, including finance, allocations and tariff design.

Places are allocated on a first come first serve basis so please e-mail bethany.clift@dh.gsi.gov.uk by5pm on Friday 14 September if you would like to reserve a place. Following receipt of your e-mail, you will be sent an electronic link to enable you to access the webinar.

Update on arrangements for GP IT systems

The GP informatics item from issue 19 of the CCG bulletin has been amended to clarify the systems and services which are being managed and funded nationally, and those which are being delegated to CCGs.

The NHS Commissioning Board (NHS CB) will be accountable for the delivery of primary care IT in the future, with funding and responsibility for GP IT (ie. hardware, network services and support services – including training – to GP practices) being delegated to CCGs.

Responsibility for other primary care IT systems (ie. for dentistry) will be managed through the NHS CB’s local area teams.

Work is underway with PCTs to determine the level of current spend on GP IT, before finalising decisions on the funding to be devolved to CCGs in 2013-14.

Meanwhile, the Local Service Provider (LSP) contract and GP Systems of Choice (GPSoC) – the programme which enables practices to choose their GP IT system – will continue to be managed and funded at a national level.  CCGs will be expected to provide appropriate support and training to their practices where they have made a choice to switch to an alternative system.

CCGs as commissioners will need to develop local strategies for sharing and using information in ways that transform quality of care, support integration of services, and empower patients.

If you have any questions about these future arrangements please contact ccgdevelopment@nhs.net

Commissioning support: Communications and engagement services

The future arrangements for communications and engagement commissioning support services have been finalised.  Four communications collaboratives are being set up with a lead commissioning support unit (CSU) in each.

The details are:

  • North of England collaborative: West Yorkshire CSU
  • Midlandsand East of England collaborative:Birmingham,Black Countryand Solihull CSU
  • Londoncollaborative: North West London CSU
  • South of England collaborative: Commissioning Support South CSU.

Further details are available on the our website.

In addition, two further managing directors of CSUs have been appointed. David Stout, currently Deputy Chief Executive of the NHS Confederation, has been appointed Managing Director of Hertfordshire CSU and of Essex CSU and will take on the role from October 2012. They will continue to be run as two separate CSUs.

Tim Andrews will be Managing Director of Cheshire,Warringtonand Wirral CSU. Tim was previously interim Managing Director of the CSU and Managing Director of the Commissioning Lab.

Guiding CSU development and becoming informed customers

The CCG Commissioning Support Reference Group will meet for the first time in October. Comprising nominated clinicians and managers from all four regions, the reference group will help guide the development of national commissioning support processes and scale services, as well as contributing to fostering excellent relationships between CCGs and CSUs.

The NHS Commissioning Board (NHS CB) is also planning a series of activities throughout Autumn/Winter 2012 to help CCGs become better-informed customers of commissioning support suppliers. Look out for more details, which will be distributed via email and posted on the NHS CB website soon. The activities and support packages will include:

  • Sample key performance indicators and service specifications for CCGs to use with their commissioning support suppliers
  • Quick guides to particular issues CCGs are experiencing in developing relationships with commissioning support suppliers, such as governance and agreeing clinical added value
  • National workshops for CCG and CSU leaders to work through strategic issues relating to the national development of commissioning support
  • Local workshops for CCGs and CSUs to work through common commissioning support challenges together.

Join the NICE quality standards advisory committee

NICE is looking for clinical commissioners and managers to join one of the independent committees that will be responsible for developing quality standards to be used for commissioning and driving quality improvement. The quality standards will also be used to underpin the Commissioning Outcomes Framework.

More information on how to apply for the advisory committee and information on the NICE quality standards can be found on the NICE website.

You can also contact Jenny Harrison at NICE on jenny.harrison@nice.org.uk or by calling 0161 870 3269. The closing date for applications is25 September 2012.

Payment by Results in 2013-14

CCGs are being asked to familiarise themselves with the latest information on Payment by Results (PbR).

The annual PbR ‘sense check’ exercise will start later this month and last four weeks. This is the stage in the development of the national tariff where the Department of Health shares draft prices with a number of clinicians and NHS organisations in order to identify any anomalies or perverse clinical incentives.

The exercise also tests the robustness of the Department’s impact analysis by asking a number of providers and commissioners to assess the impact using up-to-date local activity data.

A letter from Deputy NHS Chief Executive David Flory will be published on the Department’s website, which will set out the likely shape of PbR arrangements for 2013-14. CCGs will be able to find the letter on the PbR page on the DH website when the sense check begins in late September.

News in Brief

  • Proposed CCGs are reminded that a financial governance tool is available on the NHS Commissioning Board Authority’s website. This tool should help CCGs with preparing for both establishment and their applications for authorisation.
  • The next NHS Change Model webinar is on 21 September from 8.30-9.30am. The NHS Change Model is a dynamic framework that pulls together everything we know about delivering successful improvement in the NHS. The seminars will be recorded so if you miss any you can catch up at another time. Find more about the online seminars and register for the series.
  • The Network of Public Health Observatories has updated the Spend and Outcome Tool (SPOT). SPOT is one of the key health investment tools which enables commissioners to examine the relationship between expenditure and a range of health outcomes by disease area. SPOT now includes the latest programme budgeting data for 2010-11. Outcome indicators have been updated and new ones added, e.g. Patient Reported Outcome Measures. The latest version of the tool, and individual factsheetsfor each PCT, are available.
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